Supplementary materials: MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke

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posted on 2024-04-12, 15:28 authored by Osama O Zaidat, Shelly Ikeme, Sunil Sheth, Shinichi Yoshimura, Xin-guang Yang, Waleed Brinjikji, David Kallmes, Patrick Brouwer, John Pederson, Ranita Tarchand, Annie Steffenson, Kevin Kallmes, Jillienne Touchette, Tommy Andersson

These are peer-reviewed supplementary materials for the article 'MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke' published in the Journal of Comparative Effectiveness Research.

Supplementary Table 1: Search terms
Supplementary Table 2: Studies excluded for potential population selection bias
Supplementary Table 3: Study and patient baseline characteristics at the study level
Supplementary Table 4: Combined (EmboTrap, Trevo, and Solitaire) ordinal mRS scores across treatment groups.
Supplementary Results 1: Ordinal mRS scores at 90 days
Supplementary Results 2: Core-lab subanalysis:
Supplementary Results 3: Prospective-only subanalysis.
Supplementary Table 5: Comparison of recanalization outcomes between EmboTrap®, Trevo, and Solitaire among studies with outcomes adjudicated by a core-laboratory.
Supplementary Table 6: Comparisons of functional, safety, and recanalization outcomes between EmboTrap®, Trevo, and Solitaire among prospective studies.
Supplementary Figure 1: Outlier and influence analyses of rates of mRS 0-2 at 90 days
Supplementary Figure 2: Forest plot of comparisons of mRS 0-2 at 90 days.
Supplementary Figure 3: Forest plot of comparisons of mRS 0-2 at 90 days.
Supplementary Figure 4: Outlier and influence analyses of rates of mortality at 90 days
Supplementary Figure 5: Forest plot of comparisons of mortality at 90 days.
Supplementary Figure 6: Forest plot of comparisons of mortality at 90 days
Supplementary Figure 7: Outlier and influence analyses of ENT rates
Supplementary Figure 8: Forest plot of comparisons of ENT/distal emboli.
Supplementary Figure 9: Outlier and influence analyses of sICH rates.
Supplementary Figure 10: Forest plot of comparisons of sICH.
Supplementary Figure 11: Forest plot of comparisons of complete or near-complete recanalization on first pass (FPR mTICI ≥2c).
Supplementary Figure 12: Forest plot of comparisons of successful recanalization on first pass (mFPR mTICI ≥2b).
Supplementary Figure 13: Forest plot of comparisons of final complete recanalization (TICI 3).
Supplementary Figure 14: Forest plot of comparisons of final successful recanalization (mTICI ≥2b).
Supplementary Figure 15: Forest plot of comparisons of complete or near-complete recanalization on first pass (FPR mTICI ≥2c) among core-lab adjudicated studies.
Supplementary Figure 16: Forest plot of comparisons of successful recanalization on first pass (mFPR mTICI ≥2b) among core-lab adjudicated studies.
Supplementary Figure 17: Forest plot of comparisons of final complete recanalization (TICI 3) among core-lab adjudicated studies.
Supplementary Figure 18: Forest plot of comparisons of final successful recanalization (mTICI ≥2b) among core-lab adjudicated studies
Supplementary Figure 19: Forest plot of comparisons of successful recanalization on first pass (mFPR mTICI ≥2b) among prospective studies.
Supplementary Figure 20: Forest plot of comparisons of final complete recanalization (TICI 3) among prospective studies.
Supplementary Figure 21: Forest plot of comparisons of final successful recanalization (mTICI ≥2b) among prospective studies.
Supplementary Figure 22: Forest plot of comparisons of ENT/distal emboli among prospective studies.
Supplementary Figure 23: Forest plot of comparisons of sICH among prospective studies.
Supplementary Figure 24: Forest plot of comparisons of mRS 0-2 at 90 days among prospective studies.
Supplementary Figure 25: Forest plot of comparisons of mortality at 90 days among prospective studies.

Aim: Stent-retriever (SR) thrombectomy has demonstrated superior outcomes in patients with acute ischemic stroke compared with medical management alone, but differences among SRs remain unexplored. We conducted a Systematic Review/Meta-Analysis to compare outcomes between three SRs: EmboTrap , Solitaire™, and Trevo. Methods: We conducted a PRISMA-compliant Systematic Review among English-language studies published after 2014 in PubMed/MEDLINE that reported SRs in ≥25 patients. Functional and safety outcomes included 90-day modified Rankin scale (mRS 0-2), mortality, symptomatic intracranial hemorrhage (sICH), and embolization to new territory (ENT). Recanalization outcomes included modified thrombolysis in cerebral infarction (mTICI) and first-pass recanalization (FPR). We used a random effects Meta-Analysis to compare outcomes; subgroup and outlier-influencer analysis were performed to explore heterogeneity. Results: Fifty-one articles comprising 9,804 patients were included. EmboTrap had statistically significantly higher rates of mRS 0-2 (57.4%) compared with Trevo (50.0%, p = 0.013) and Solitaire (45.3%, p < 0.001). Compared with Solitaire (20.4%), EmboTrap (11.2%, p < 0.001) and Trevo (14.5%, p = 0.018) had statistically significantly lower mortality. Compared with Solitaire (7.7%), EmboTrap (3.9%, p = 0.028) and Trevo (4.6%, p = 0.049) had statistically significantly lower rates of sICH. There were no significant differences in ENT rates across all three devices (6.0% for EmboTrap, 5.3% for Trevo, and 7.7% for Solitaire, p = 0.518). EmboTrap had numerically higher rates of recanalization; however, no statistically significant differences were found. Conclusion: The results of our Systematic Review/Meta-Analysis suggest that EmboTrap may be associated with significantly improved functional outcomes compared with Solitaire and Trevo. EmboTrap and Trevo may be associated with significantly lower rates of sICH and mortality compared with Solitaire. No significant differences in recanalization and ENT rates were found. These conclusions are tempered by limitations of the analysis including variations in thrombectomy techniques in the field, highlighting the need for multi-arm RCT studies comparing different SR devices to confirm our findings.